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©2017 Kella Hanna-Wayne. 

How to Lend a Hand in a Mental Health Crisis Part 2: Mindset, Limit Setting, and Safety Assessment

December 25, 2018

 

This week’s guest post is Part 2 in a series that looks at the gaps in our current mental health care system and provides information on how to fill those gaps on an individual basis. Today’s post covers the preparation needed to skillfully offer support to a friend if you don’t have the resources to become a trained crisis worker but still want tools to help your friend when in a crisis. 

 

CN: discussion of suicide, suicide ideation and planning, mental health crises, abuse; brief mentions substance use, and professional intervention.

Hi all,

 

Alright; back in Part 1, I talked about my experiences with calling a hotline during my own mental health crisis, how I later became a volunteer crisis counselor myself, and how to find opportunities to train to work or volunteer for a crisis line in your area if you want to.
 

But, I know not everyone has the time or opportunity to become a trained counselor. At the same time, maybe you feel for your friends in crisis, or you want to have the skills on hand to help a friend or relative who reaches out to you. That’s a good and noble goal.  
 

There are a lot of people who want, emphatically, to help their friends who are in the midst of a mental-health emergency, but, lack the tools and strategies to help effectively. Unfortunately, in the worst cases, well-intentioned friends’ methods of helping actually backfire and wind up pushing the person in crisis towards destructive choices. 
 

Fortunately, in the best case scenarios, people genuinely ARE able to lead their friend out of crisis-mode.  With a little knowledge and practice, you can learn to help lead a friend in crisis into a mentally and emotionally safe space, where they can come up with short-term, medium-term, and long-term plans to resolve their most pressing issues. 
 

The next four parts of this guide will take you through what to do, step-by-step, in order to help guide someone from a mental or emotional crisis to a mental place of safety. This article specifically is designed to set you up for success by going in-depth with three specific actions you can take before you help someone process during a mental-health crisis.
 

Today we’re looking at how to:

 

  1. Embrace a ‘Three-C’s’ Mindset

  2. Set Limits on Behavior

  3. Assess How Much Danger Someone Is In
     

 
Embrace a “Three C’s” Mindset: Calm, Competent, and Compassionate

 

Calm
 

Calm body language, voice tones, and facial expressions convey a sincere belief that no matter how severe your friend’s pain or issue is, you and they have the power to work through it together. Much like confidence, it’s okay if calm is a “fake it ‘til you make it’ thing for you. 

Did you know body language can impact your emotions just as much as the reverse?


Intentionally choosing to sit a way that conveys calm can actually work to calm your own emotions while you help your friend. [source] [source]
 

Additionally, using calm body language and tone of voice can cause your friend to subconsciously mimic your body language. This subconscious imitation of expressed emotion is natural, and we often don’t realize we’re doing it. This is why it is difficult, for example, to de-escalate a heated argument: the natural response is to match angry body language with anger. [source]
 

This emotion-matching can be used for good if your distressed friend begins to match your calm body language and tone of voice, letting some of their fear dissipate. 
 

Competent 


Competent is a kind of self-knowledge that comes from practice. Competent means being confident in your ability to figure out solutions and while being present with your friend. 

 

Calm is an emotional state-- a real or projected sense of inner peace. Competent is an intellectual belief. Competence is being able to say to yourself, “I may not have all the answers, but I have the determination and the skills to figure them out.” 

 

One way to show competence is to focus on present listening. When you listen to what your friend is saying, try to stay in the moment with them. Don’t do the thing where you half-listen, half-try-to-think about what to say next, or about how you could solve their problem. Just listen.

 

When listening, react naturally to their story. Nod, lean in, make a natural amount of eye-contact. It’s okay to not, like, stare them down; that can be unnerving. Just, don’t look like you’re distracted by looking at your phone or wandering around the room. Show you’re giving them your full attention.

 

Making kind vocal sounds, or even reacting verbally, if that’s natural for you, can also help your friend feel heard. If your friend describes being treated horribly by someone, saying something natural like, “Whoa, that was not okay for them to do,” or even, if it’s in your vernacular, “Damn, that’s fucked up” can feel really validating.

 

Likewise, if your friend is expressing pain that you can’t relate to personally, but you still want to acknowledge how bad their pain is, you might say, “That sounds painful” or “I’m sorry that’s happening to you.”


Compassionate

 

Compassionate means, in this moment, you are prioritizing your friends’ needs over others. You are not here for ten people at once; you are here for your friend only for the length of time you’re working through the crisis. 

 

It also means you’re prioritizing your “role” as a counselor, for the time being, over other roles you might play in your life. Some people find themselves in the role of “judge” or “referee” if they are frequently the go-to person to resolve conflicts in their friend-group or family. Others, especially those involved in social justice movements or activist circles, may often be in the role of “educator” in other contexts. 

 

If you are choosing to help your friend through a crisis, though, then for the duration of this context, the role of crisis counselor is your priority. Compassion has to become more important, in the moment, than teaching or judging. 

 

 

Another way to think about compassion is that it is distinct from empathy. Empathy is great! But, empathy means feeling an echo of someone’s emotions in your own body. For example, if something sad happens to a character in a movie, an empathic person might feel that sadness in their own body and tear up. 

 

In a situation where your friend is experiencing extreme emotions, empathy can actually get in your way. Compassion lets you be there, present, for your friend, while staying fully “you.” Rather than letting yourself experience an echo of their fear or anger and getting stuck in it, remember while you are listening closely to them that you, yourself, are not in danger right now. The fact that you are not in danger means you have the ability to help in concrete ways.

 

A compassionate mindset also lets you take your time and fully process someone’s emotions with them because you don’t feel their anxious pressure to solve all their problems right now. 

 

Once you’ve gotten into the ‘Three C’s’ mindset, sit down with your friend-- ideally somewhere where you won’t be interrupted. It’s okay if you have to do this over the phone. Because in-person and phone conversations let you and your friend express yourselves through your voice tones and, in face-to-face talks, body language, they're more comforting and more helpful for most people. 

 

However, for some people with auditory processing problems or certain phobias, text-based communication can be better. While I don't have personal experience with crisis counseling over text or instant messaging, others have found it helpful, and it's likely that some of these strategies still apply to text-based crisis conversations. 

 

If your friend is having trouble speaking, and you are together in person, encourage them to write what they’re feeling down, or type it out. Even if you are both writing, stay present with them. One potential pitfall of a text-based conversation is you risk getting distracted; the best way to help someone feel heard or seen is to stay in the moment with them, regardless of where you are physically.  

 


Set Limits on Harmful Behaviors


Why is setting limits on harmful behaviors-- creating boundaries-- important in a mental health crisis context?


Someone with a reputation for having solid boundaries is often also widely known as kind and compassionate. People who need help know that when a person with good boundaries listens to them or helps them, that person is truly choosing to.

 

On the other hand, if you don’t follow through and enforce your boundaries, you will gain a reputation as someone who can be easily taken advantage of. Boundaries you can’t enforce with action are boundaries in name only. 

 

Speaking from personal experience, knowing that someone intentionally chose to listen to me and help me out is deeply gratifying. I know I feel uncomfortable in situations where I worry that, simply by being assertive about my needs, I might’ve bullied or manipulated someone into helping me when they didn’t want to. 

 

When I know someone has good boundaries and they’re good at saying “no,” I don’t have to worry about whether their “yes,” actually means “yes.”

 

 

What Makes Setting Limits on Behavior So Challenging?  

 

Creating boundaries is tough because many of us come to believe that having boundaries is selfish.

 

But! Having boundaries is the opposite of selfish.

 

When people around you know that your “Yes” truly means yes (because your “no” is clear and non-negotiable), they will feel more comfortable asking you for help when they need it. And, your friends who may be anxious that you’re only hanging out with them out of pity will have than anxiety eased. Boundaries empower people to trust you by showing that you are trustworthy. 

 

If that isn’t a good enough reason for enforcing your boundaries around people’s behaviors, I’m going to borrow a turn of phrase from the writer Joon Madriga: “The mirror-twin of the golden rule is, ‘love thyself as much as you love thy neighbor.’”  Are you treating yourself with the love that you extend to others? 

 

If you had to give advice to your favorite person, maybe your little sibling who looks up to you, would you advise them to endure any kind of poor treatment, and take on every emotional cost, to help someone else? Or would you advise them to have a line? 

 

 
How to Set Limits on Behavior

 

At our crisis center, we have a very effective, concrete method of setting and enforcing boundaries.

 

First, identify what specific behaviors are unacceptable for you during this conversation. Common boundaries people often want to protect are: a limit against your friend yelling at you, insulting you, sexualizing you, or wasting your time by repeating the same thing over and over again. 

 

You’re the boss of your own time and emotional labor, so feel free to set limits on any behavior that crosses your personal boundaries. 

 

Next, when your friend does something unacceptable, do this:

 

In the same compassionate, competent and calm tone of voice you’ve been using, interrupt your friend before they get too far in their lashing out or repeating themselves. I know interrupting feels rude, especially if you’re a naturally good listener! But, you’ve pretty much got to. 

 

When you interrupt, you need to:

 

✭ Name the behavior
✭ Explain how that behavior is disrupting your conversation and getting in the way of your goals here

 

and

 

✮ Explain how if they continue that behavior, you’ll have to go.

 

But! 

 

✮ If they replace that behavior with a positive behavior, y’all can keep talking and working through this. 

 

 

The formula sounds like this: “If you do [x], it [has this effect]. When [the effect] happens, I really can’t focus on you or listen to you well enough to help you.” 

 

At this point, they might apologize and say that they’ll stop, which is great! But, if they don’t, you don’t really have to pause. 

 

Just keep going and say, “So, if you keep doing [x], I’m going to [leave/hang up]. But if you do [y] instead of [x], I feel like we can keep going, and really figure out where to go from here in a positive way. What do you want to do?”

 

 

Now, you don’t have to say it like a robot. As long as you’re assertive enough to keep talking even if they try to talk over you, use as much of your own vernacular and filler words as feels comfortable for you. Especially if you’re helping someone you’ve known a while, it’s best to approach behavior limit setting with a posture and tone of voice that suggests that your friend just got a bit carried away, and that you believe that they genuinely want to have a comforting, productive conversation. 

 

So, in real life, it might sound like, “Hey, dude, please don’t yell at me or insult me like that. You know this isn’t my fault. When you raise your voice and insult me, I get all flustered and kinda pissed off, and when I’m all flustered I can’t focus on what you’re actually really saying. So I can’t help you.

 

“If you keep insulting me or raising your voice, I’m gonna leave, because there’s no point in me staying to help you work through this if I’m flustered and kinda mad at you over this one thing. But, listen, if you can just talk about what happened more quietly, without insulting me, I can stay and I think I can help you work through this.” 

 

 
How to Adjust your Phrasing to Convey a Boundary with Less Intensity

 

For a behavior that isn’t emotionally harmful, but is frustrating and a time-sink (like the person who repeats what they already said several times), it can help to set boundaries with softer phrasing.

 

So, you might say, “Ah, listen mate, you already said that. You’re talking about______” Then reflect or summarize what they’ve already said. They will likely affirm and agree that that’s what they were about to talk about again, at which point you can ask an open-ended question that can help them focus. Something like, “So what happened after [the last part of the story]?” or, “What makes [this detail or part of the event] really stick in your mind like that?”

 

However, if the person doesn’t realize they've begun to repeat themselves, or if they get angry with you for pointing out that they’ve started their story over from the beginning, then it can be helpful to bring out the more standard formula to set a limit on their behavior. In my experience, being unable to remember what they’ve already said suggests a degree of intoxication that basically makes crisis counseling unworkable; frequently, if they can’t remember repeating themselves, they won’t remember any of their own conclusions, nor any resources you managed to give them. 

 

Here's an example of what setting limits can sound like in a scenario where someone is repeating themselves: 

 

“When you repeat whole segments of your story like that, I can’t follow you closely and I feel confused. If I’m confused, I really can’t help you. So if you keep repeating what you already said, or jumping back to the beginning, I’m just gonna go, because there’s no way I can help you when I’m that confused. But if you can talk in a straightforward way, I can follow you, so I’ll stay.” 


Enforce Workable Consequences

 

One last thing about setting boundaries: The only consequence that makes sense to enforce is leaving the conversation or hanging up the phone. There aren’t any “middle ground” or “three strikes” consequences that work, and the ones I’ve seen people attempt-- not at the crisis line, just out and about in life--come across as really infantilizing. You’re not your friend’s parent. You’re not trying to discipline them into becoming better people. The purpose of setting boundaries is to protect your own emotional safety and integrity, not to teach your friend a lesson.

 

 

Assess How Much Danger Your Friend Is In

 

Before starting a conversation, it's important to find out if someone is in immediate danger. Immediate danger means they are trying to enact a plan that is suicidal or seriously dangerous (for example, taking hard drugs to cope with their pain, and potentially risking an overdose) and they have the means to do so. Alternately, immediate danger can mean they’re in an abusive situation where it is possible that they could be wounded or killed if they stay there even a day longer.

 

Assessing Suicidal Intent

 

To check if your friend is in immediate danger, the best thing to do is ask a series of questions directly, without euphemisms. Asking if they are about to “do something silly” can lead them to say, “no,” if they believe they are actually making the wise or correct choice. It can also be invalidating since it downplays the severity of their emotional state. Likewise, euphemisms like “hurt yourself” or “do something you’ll regret” can be misconstrued by a person in a crisis.

 

When you ask, make sure your tone of voice is calm, friendly, and non-judgemental.

 

 

Question #1

 

Ask: Are you contemplating suicide? 

 

If your friend says, “yes,” then ask about their plan or their means directly.

 

 

Question #2

 

Asking about a plan can be straightforward as well. Ask: Do you have a plan? 

 

If they say yes, continue to question #3.

 

 

Question #3


Ask: Are you considering enacting your plan soon? 

 

If they say yes, continue to question #4.

 

 

Question #4


Ask: Do you have the means to complete suicide?  

 

At this point, I do want to say, I know this kind of directness can be unconformable. But, it is very important to be straightforward here. These questions are concrete and direct enough that your friend will likely answer honestly. In general, it's harder to lie directly to a friend than it is to sort-of lie by omission by saying “no” but mentally re-interpreting the question.

 

 

If someone answers a question with “no.”

 

Usually, a person will say no to at least one of these questions. If they say no, you can say something like, “I’m relieved to hear it,” or whatever is honest for you. You can then say something like, “You know I’m here for you. Let’s talk about what’s going on.”

 

 

If they answer all four questions with “yes.”

 

If your friend answers “yes” to all four questions, then you can say something like, “I’m really sorry to hear that. It sounds like you’re really hurting right now. While obviously, I can’t make any guarantees, you’re my friend and I care about you. I really want to hear you out right now and try to help you through this. Is that alright? Can we try to figure out another way out of your pain besides suicide?”

 

 

Generally, a person says yes, especially if they came to you for help in the first place. 

 

When talking to your friend, you can definitely personalize that a bit. Let them know that you really do care about them, and be specific about what you love and like about them. 

 

If They Have the Means (Tools) to Complete Suicide with them Right Now

 

If they have the means immediately available, it’s good to follow up with a direct request: “I feel like it’ll be easier to try to figure another way out if you leave the means [be specific about what they said the means were, if they mentioned it] out of sight. Do you mind setting the means down and going into another room?” Again, usually, the person will say “yes.” 

 

It can be okay if they say “no.” They might not be ready yet. This may be surprising, but sometimes knowing there is an escape route, and physically handling the means, can relieve someone’s stress just enough that they stay with it. Some people will not let go of the means until they have a genuine belief that there really is an alternate, non-lethal escape route, which might not happen until later in your conversation. So, if someone says “no” to leaving the means out of sight, just continue on in the conversation and circle back to it later. 

 

If a person says yes to all of your questions and seems clearly in danger of completing suicide imminently, I would advise you to call a professional at that point. No matter how much you love your friend, the best thing you can do for them might be staying with them while you call a professional, either on a crisis line or 911. You might say, “Alright. I’m going to call a professional, okay?” or “I want to take your pain seriously because I really do believe it’s serious. I think this is too big for us to handle, even together. So, I’m going to call suicide hotline [or 911].”  

 

Remember, at the end of the day, you don’t control your friends’ actions, and it is not on you if they choose to complete suicide. While of course, it makes sense to feel for your friend, the last thing I want is for someone without training to take on that responsibility in such an extreme situation. Please take care of your own heart.  

 

That said, in the vast majority of cases, a person contemplating suicide who reaches out for help is not in such a severe state. Simply contemplating suicide doesn’t mean that someone is in urgent danger. I contemplated suicide, and I was able to get better without emergency services. 

 

 

Assessing Danger from an Abuser

 

In a potentially abusive situation, the first question to ask is, “Can you speak freely now?” If they say yes, excellent. If not, say, “Alright. I’ll stay with you, and I won’t speak up until you get somewhere you can talk safely. Let me know when you’re there.” 

 

At this point, if you know where your friend is, it might help to send someone over who can physically intervene and remove your friend from the dangerous situation. Depending on the context, this could be a mutual friend, a trusted adult like a teacher (if you are both students in an abusive-parent situation), or the police. You know your situation best.

 

If a person says they can speak freely, ask: “Are you afraid [person] might do physical harm to you? Even if you think the harm might not be a big deal, could it happen at all? Has it happened before?”

 

Usually, a person is very honest in this kind of situation. Either they are relieved to finally be able to tell someone who believes them about the danger they’re in, or they’re emphatic that, while their home life may be troubled and that is adding to their stress and overwhelm, they are not in danger. 

 

In my experience, I have never heard someone lie about being in danger from an abuser when they actually aren't. However, while it is uncommon, sometimes people lie about not being in danger from an abuser when they are, in fact, in danger. But, since your friend has reached out to you for help, it is likely that they will want to open up about it. 

 

If a person is in danger from an abuser but currently they and their abuser are in different places (so, not immediate danger), a good next step is to try to get them to a safe location.

 

A local crisis center is always a safe location, as are domestic violence shelters. Both places have well-tested security measures and precautions. However, because this person is your friend, if you want to take the risk, your first option could also be to offer to pick them up and let them stay at your home or meet them in a public space where their abuser will not want to make a scene. 

Once you’ve embraced a ‘Three-C’s’ mindset, practiced setting limits on harmful behavior, and have assessed the immediate safety of your friend (and found them to be safe, at least for now), you can help your friend begin to process their emotions and work through their mental-health crisis. 

 

In Part 3, Part 4, and Part 5, I'll be talking about how to go through the steps and strategies to help someone process their intense emotions, and, eventually, how to begin to problem-solve and find local resources. So keep reading! 

About the guest blogger: Lucy Merriman is a poet and artist living with her friends in Ohio. Her poetry has been printed in Pif Magazine, and her personal blog, Welcome to Tree City, is a fun place where she interviews artists, posts contemporary art criticism, and is generally trying to figure the big stuff out. You can also find her on Instagram on @merriman_lucy. She likes people! She probably thinks you're pretty neat.


 

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